Department of Anaesthesiology, Aarhus University Hospital, Aarhus N, Denmark.
Department of Clinical Medicine, Aarhus University, Aarhus C, Denmark.
Acta Anaesthesiol Scand. 2021 May;65(5):688-694. doi: 10.1111/aas.13782. Epub 2021 Feb 8.
Mispositioning is common during insertion of peripherally inserted central catheters. Ultrasonographic visualization of anatomical structures may enable continuous guidance during insertion. The aim was to investigate the feasibility of ultrasonographic real-time guidance of peripherally inserted central catheter placement using the supraclavicular fossa view.
An observational quality control study was performed including 20 patients. Ultrasonography was performed via the right supraclavicular fossa using a microconvex probe identifying the junction between the right internal jugular- and the subclavian vein forming the right brachiocephalic vein. The wire guide tip was identified at the junction allowing estimation of catheter length. The catheter stiffening wire was followed in real-time into the right brachiocephalic vein towards the superior vena cava. Mispositions and the ability to redirect in real-time were detected. Final catheter tip positions were evaluated by either fluoroscopy or a chest radiograph.
Catheters were successfully placed in 19/20 patients. In all patients the junction and the right brachiocephalic vein was identified. Two thrombi were identified in the right brachiocephalic vein and left-sided insertions were performed. In 16 of 17 right-sided insertions, wire guide and catheter stiffening wire were visible. Of the 16 visual catheters, 15 could be followed into the right brachiocephalic vein. Real-time mispositioning was identified in eight cases and optimal redirection was successful in seven. All ultrasound-guided catheter length estimations were adequate.
Supraclavicular ultrasonographic real-time guidance for peripherally inserted central catheter placement was feasible and enabled successful placement together with detection and redirection of mispositioned catheters without delay.
在经外周置入中心静脉导管（PICC）置管过程中，导管错位很常见。超声可视化解剖结构可实现置管过程中的连续引导。本研究旨在探讨锁骨下窝视图超声实时引导 PICC 置管的可行性。
本研究为一项观察性质量控制研究，纳入 20 例患者。通过右锁骨上窝使用微凸探头进行超声检查，以识别右颈内静脉-锁骨下静脉交界处，形成右头臂静脉。在交界处识别导丝尖端，从而估计导管长度。导丝引导器实时跟踪硬导丝进入右头臂静脉，直至上腔静脉。检测导管的错位情况，并实时进行重新定位。通过透视或胸部 X 线片评估最终导管尖端位置。
20 例患者中 19 例导管成功置管。所有患者均能识别交界处和右头臂静脉。在右头臂静脉中发现 2 个血栓，进行了左侧置管。在 17 例右侧置管中，16 例可观察到导丝和导管硬导丝。在 16 根可视导管中，有 15 根可进入右头臂静脉。8 例实时检测到导管错位，7 例成功进行了最佳的重新定位。所有超声引导的导管长度估计均准确。
锁骨下超声实时引导 PICC 置管是可行的，能够实现成功置管，并在不延误的情况下检测和重新定位错位的导管。
